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    I get shoulder pain after playing for a while?

    Shoulder pain and discomfort are common among musicians. There are different causes and combinations of causes, that can result in shoulder pain.
    1. It is important to warm up physically before you start to play so that blood circulation is increased to the muscular structures that will be used during playing. See exercise…
    2. Consider how you plan your practicing as regards its length before taking a break, and exactly what you focus on during practice sessions. Review the section on practice planning.
    3. Be sure to position your body in such a way that the correct muscles are used for stability and power, and others are used for movement and function according to the instrument’s requirements. This reduces fatigue and discomfort. Review the information on stable sitting and standing positions.
    4. You may be weak in certain muscles that are needed for optimal support and thus, other muscular structures compensate, which leads to poor function in the long run. Review the large elastic band exercises.

    When playing the violin I feel a burning, grinding feeling in my shoulder blades, mostly on the left side.

    This happens when the left shoulder tends to move upward and turn forward to provide stability for the instrument. It results in the shoulder blade sliding out to the side and the muscles between the shoulder blades are working extra hard in an extended position. The underlying cause is usually weak stability in the chest cavity that extends downward to the pelvic area, and the shoulder-lowering muscles are weaker than those that raise the shoulders. Another cause may be the length of time you play before taking a break. Review the sections on stable sitting and standing positions, and practice time blocks.

    I have recently started practicing and am playing more flute. I wonder if there are specific exercises I should do to avoid injury.

    Be sure to do some physical fitness training 2–3 times a week. This can include yoga, gym workouts, general exercise classes, brisk walking or exercising at home with a large elastic band. Do what you think is fun, raises your pulse rate and challenges your muscles. Exercise especially, the contrasting movements to playing, in order to strengthen those muscles. This enables the muscles that work less often (muscles of the back and back of the arms) to become stronger. You can also include exercising during your practice breaks to reset muscular balance and increase circulation in the muscles used for practicing.

    Core training and shoulder-lowering exercises are always good for the musician’s physical well-being. Don’t forget to support the stability and function of your hand muscles. Review the large elastic band exercises and hand exercises.

    In addition, it is important to warm up your body before warming up with your instrument. When you increase your pulse rate and circulation first, you make it easier for the muscular structures to begin their work. Practice with a specific plan in mind of what you want to focus on and take breaks every 10–20 minutes, depending on what you are practicing. Be sure to increase your awareness of how you stand and sit, so that you get optimal support from your body when making playing.

    I love playing the guitar, but I’m worried now that I cannot continue with it because I’ve developed a sharp pain in my thumb. There are certain hand positions that are more painful than others and I can feel the pain in other daily activities. What should I do?

    Consider carefully how you use your thumb and if it tends to be overextended (hypermobility). This is a common situation and the position creates great stress on the large joint of the thumb near the hand. It is also painful on the inside of the palm. This tension spreads and hampers the function of the other fingers. You don’t mention if it is in your right or left thumb, but the left thumb of guitarists can often become overextended during playing and when pressing hard on the neck of the guitar. The grip becomes too tight and builds up tension in the arm. The left thumb is also positioned statically on the back of the neck, instead of moving up and down the neck.

    An additional aspect to consider is if you can allow the thumb to be a support and not constantly pressing on the front of the neck of the guitar. We call this static and peripheral positioning and often support is lacking from the entire arm, shoulders and back. Try to improve this by lifting your arm slightly towards the back as a way of relieving finger pressure on the strings. If you can find this enhanced position, the thumb will not need to work as hard pressing on the back of the guitar’s neck. Review ergonomics for guitar players and video.

    The tendency to overextend the thumb is caused by a weakness in joint stability and muscular structures. The muscles that extend the thumb’s base joint need to be strengthened. Review the section on hand exercises. It takes time to establish new thumb positioning, but it is necessary to do so to avoid chronic problems in the future. Thumb and hand videos.

    Often a slouching sitting posture can make it difficult to get support and stability from larger muscular structures in the back, pelvic region and legs. Power and stability move upwards and outwards, and create too much tension and work for muscles that are needed for finer movements than stability. When you position your body with awareness for optimal stability when sitting and standing, you put in place important functional support for long-term optimal playing. Review stable sitting and standing positions.

    I sometimes have a little pain in my right hand (fourth finger’s outer ligament) and feel I need help to improve my technique. I play the piano.

    For the best possible functioning of the hand and fingers, the muscles of the palm must be strong and flexible during playing. Exercising these muscles specifically is important. See hand exercises. In addition, it is also important to have contact with, and support from the back, shoulder blades and legs for hands and arms. Often when pianists have a problem with their hands, there is too much power and activity out in the peripheral areas of the hands and fingers, and so the necessary support from the larger muscles is lacking. See piano practice.

    I wonder which clinic in Malmö I should go to for help with pain in my hands. I have not had problems with this for very long, but I would like to get it cleared up before it develops into something worse when I start studying at the college of music in the fall.

    This is an excellent initiative – checking out a possible problem before it causes major difficulties in your musical career. You can make an appointment with our physiotherapist Ing-Marie Olsson or MD Karin Engquist.

    I play a lot of piano and have done so all my life. But recently I have developed a lot of pain in my left hand when I play, especially in my little finger. It feels like the muscles in my hand, on the left side where the little finger moves, start to cramp and stiffen. It is very painful and I don’t know if it is an inflammation or some kind of blockage. What can be done about it? How do I get in touch with Artist- och Musikerhälsan? Do I need a referral or can I contact you directly with no difference in the cost?

    The little finger is often overworked when playing the piano or violin. This is usually caused by intense practice which overworks the little finger, e g large hand stretches or drills. Start by considering how long you practice before taking a break. As long as you have pain, your breaks should be taken every 3–5 minutes and you should do something that increases circulation in your hands and arms during them. Weak palm muscles can contribute to this negative situation. Review our section on hand exercises for more help.

    Your maintenance of a sitting position that is stable and supports the hand, may be less than optimal, adding to this problem. Often, tension in the shoulders and constricted breathing are an added component. See piano practice.

    To get in touch with us at Artist- & Musikerhälsan is very simple. Just contact the specialist on our team that you think is the most suitable to help you. In this case either a doctor, piano pedagogue or physiotherapist should be contacted. Send an email or call to make an appointment. No referral is needed. We are however, a private clinic so the national cost limit program does not apply and you must pay for the visit yourself.

    Karin Engquist och Ing-Marie Olsson
    Artist- & Musikerhälsan
    Östra Rönneholmsvägen 9B
    211 47 Malmö
    Phone: +46 (0)708 670 647

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